Eliot Lazar is the Chief Medical Officer of the New York Presbyterian Healthcare System (NYPHS) and as such was personally involved with his institution’s response to the 9/11 disaster. His absorbing, extensive and at times moving presentation led us graphically through some of the horrors of the day itself, and then some of the lessons learned and how approaches to emergency planning have evolved as a result. The NYPHS is a major provider in the city and surrounding areas, and covers two major university teaching hospitals and dozens of smaller institutions totalling some 12,000 beds: a similar scale to our old Regions, though by no means the monopoly provider. Indeed, the complexity of inter-agency interactions that come into play in a disaster such as 9/11 are truly staggering.
However carefully one plans, and in whatever detail, something will likely catch you out. Patient flows are entirely unpredictable: victims will gravitate towards hospitals wherever they find them, not ‘rescue centers’ or wherever else they have been directed. Communication is critical but communication systems may be victims of the original disaster. [I understand that in this country the police have the power to take over and if necessary shut down our mobile phone networks in such circumstances). Manpower is not an issue: there was no shortage of volunteer manpower after 9/11 and the problem was turning many away without appearing ungrateful: wanting to help in an emergency is a powerful basic urge.
Disasters on this scale do not affect a single hospital but whole health care systems. Co-ordination between hospitals themselves and with hosts of other agencies is vital, and the ability to move surplus resources from one are to another more needy is essential. This needs the ability to generate rapidly inventories of available resources and communicate the information widely. Web-based systems are excellent for this, though what happens when the network infrastructure is also damaged was not mentioned. Interestingly, in ‘desktop’ exercises since the event, nurse shortages have been highlighted as a major potential problem.
At one point, Eliot asked how many of us had had discussions with our families about what we would do if struck by disaster. None of us had. This is apparently big stuff over the pond, and what we should be doing is detailed here.
Eliot and his colleagues have clearly been profoundly affected by their experience and have worked tirelessly to develop and disseminate good practice guidelines one hopes will never be needed. My sense is that major incident planning is fairly well developed (if not rehearsed as realistically) in the UK. As Eliot pointed out, we were there first, with the Blitz, but there are still things to learn for tomorrow.
